Certificate of authenticity?

Like many of his fellow physician-executives, Michael Perry moved into a management role almost by accident about five years ago, when he was recruited in May 1999 for a job as chief physician officer at Freeport Health Network in northwestern Illinois. At the time, Perry's admittedly slim background in management consisted of "a single summer business course my entire career."

Since then he's made up for lost time, earning more than 150 hours of continuing medical education in subjects such as accounting, human resources, finance and marketing through the Tampa, Fla.-based American College of Physician Executives. He topped off that business background in March 2002 with an intensive, 4?-day educational and testing program designed to replicate the rigorous process that physicians undergo when they seek board certification as specialists.

For Perry, his official status as a certified physician-executive highlights a "very steep learning curve" that began with that first managerial role six years ago this month and has culminated in a rapid ascent at Freeport Health, where his comparatively modest beginnings as chief physician officer ultimately led to his recent appointment as the system's chief executive officer. Perry, who opted for the ACPE's management-training program and certification plan rather than the more traditional route of a master's degree in healthcare administration or MBA, will take over the network's top job on Jan 1.

"I liked the idea of being taught by physicians," says Perry, who is now the system's executive vice president. "An MBA is a more generalized degree, more theory. The certified physician-executive program is more practical, more down-to-earth. The CPE is pretty much the capstone of everything you've ever learned-it puts it all together."

Perry, a family-practice physician who will be 53 in early July, is one of only about 980 doctors who have earned their official stripes as certified physician-executives, a program the ACPE launched eight years ago. Along with identifying rising stars among physicians and verifying their skills and knowledge, it was intended to provide some impetus to the idea of eventually creating a medical specialty in physician management.

"We'd like to think it's an elite group," says Marvin Kolb, a CPE who is vice president of medical affairs at St. Michael Hospital in Milwaukee and president of the ACPE. "I would think that as recruiters and organizations look increasingly to physicians for leadership roles, this (certification process) demonstrates their commitment to education, training, experience and competence. It's a way of saying this individual is really committed to education but also has a track record of results and experience."

For now, the titles are bestowed by the Certifying Commission in Medical Management, a not-for-profit ACPE affiliate. Down the road, if the ACPE has its way, the certificate will one day be the equivalent of a board certification for doctors in management, essentially a new medical specialty for doctor-administrators.

Whether or not that happens-and it's a long shot-the CPE designation has definitely developed a newfound status along with some signs of increased interest from would-be doctor-executives. The ACPE says it was approached about the program by U.S. Surgeon General Richard Carmona, who has extensive experience in management and administration. His resume includes stints as a chief medical officer; CEO of Kino Community Hospital in Tucson, Ariz.; and director of the public health system in Pima County, Ariz.-a job from which he was forced to resign in 1999, about 18 months before his contract ended, after criticism from government officials about a mountain of debt.

But Carmona did not have to attend the CPE sessions to win his latest accolade-he was granted a certificate based upon his background alone. It will be presented to him when the ACPE gathers this week for its annual meeting in Boston, where Carmona will speak at an induction ceremony for fellow CPEs.

"He was already so experienced in this field that we told him we would be honored for him to be a CPE," says Barbara Linney, vice president of career development at the ACPE and the administrator of the trade group's Certifying Commission in Medical Management.

Executives by default

Physician-executives have come a long way in recent years. It once was a term used to describe doctors who somehow-often as a result of coincidence, inertia or factors far beyond their own control-found themselves thrust into a managerial role at a hospital, medical group or clinic (See related story, p. 34).

The narrow definition has expanded in recent years, encompassing an array of positions-including president and CEO-as more and more physicians gravitate toward managerial posts in response to the hassles of managed care, stepped-up government regulation, lifestyle issues and decreased reimbursements.

Considering the heightened interest in advanced degrees, certificates and the prestige that comes with an alphabet soup of titles after a surname, a diploma in physician management was almost inevitable. It's also a solid source of revenue for the ACPE, which charges $2,200 in tuition for a program that lasts for just more than four days.

Of course, it's sometimes difficult to gauge the true impact, or prestige, of this kind of a certificate program even if the stated prerequisites include holding either an MBA or a minimum of 150 hours of accredited management courses. In other words, what is the true value of a program of this type? Is it just window dressing, another official-looking piece of paper to frame and place on the office wall with all the rest of the plaques, honors and awards?

"It's like going to any continuing education program," says Errol Biggs, director of graduate programs in health administration at the University of Colorado-Denver, where he is also director of the Center for Health Administration. "It's obviously not a degree but a certificate."

"It's probably not going to hurt you," he adds.

Fritz Wenzel, another highly regarded healthcare academic who is a graduate school business professor at the at the University of St. Thomas in Minneapolis, suggests that this kind of certification is really nothing more than a reinforcement of the work that's already been done by most of its recipients. He doesn't think that the program, by itself, will provide much more advanced training for these candidates.

"I believe that all education is helpful," he says, "but I think that if the expectation is that the person going to a 4?-day course would go in not as a physician-executive and come out a physician-executive is a long stretch."

On its Web site, the ACPE says, "For the physician-executive, board certification in medical management can be the key to success in today's competitive healthcare environment. CPE certification can be a valuable credential that can help you advance your career, enhance your credibility and attain the satisfaction of reaching a major achievement."

The promotional material on the Web site suggests that the Certifying Commission in Medical Management is identifying and certifying physician-executives who "have reached a level of excellence within the medical management profession." It also points out that the program focuses on tutorials that allow participants to "practice management techniques in front of a video camera" to evaluate communications skills.

For her part, Linney acknowledges that the real learning by these newly minted physician-executives occurs long before they kick off the certification program on a Sunday afternoon with a discussion of communications strategies and a seminar on "career assessments." Each participant, she says, must be a licensed M.D. or D.O., hold a board certification in a clinical specialty and have either a graduate management degree or 150 hours of tested management education, including courses in health law, financial decisionmaking and marketing.

She says about 60% of all CPEs have some type of a master's degree in management-such as a master's in public health, business administration, medical management or hospital administration. The rest have accumulated the 150 hours necessary for admission into the program. A credentials committee must approve the individual for participation.

Before the certification program was introduced, physicians took a written test supervised by the American Board of Medical Management, an earlier ACPE affiliate that certified graduates in much the same way the organization does under CPE. Now, in addition to seminars on topics like organizational politics under the more up-to-date curriculum of the CPE, sessions include a distinct focus on communications skills, with several programs that involve videotaping participants.

Linney, the program's director, says potential employers were asking for more than the standard testing available through the ABMM.

"They wanted certification that this person was good on their feet in terms of speaking and communicating," she says. "You have to have good communication skills as a leader. No matter how much knowledge you have, if you can't communicate, it won't do any good."

The CPE program, offered twice a year with as many as 56 students who form eight small groups for exercises, includes lectures and workshops on mentoring, communication styles, organizational politics and dealing with disruptive physicians. Physician-executives also work on listening skills because, Linney says, "If you don't get out there in the organization and pay attention, asking people how things are and hearing what they tell you, you're not going to be able lead them very well."

Not all of the sessions are intellectually demanding. In some ways, the programs seems more like career counseling for ambitious executives, with seminars on such weighty topics as interviewing techniques, negotiating salary and networking. When the course work turns to the subject of "executive image," Linney says, participants are provided tips on everything from how to walk, talk, stand and dress ("Wear a good-looking dark suit," Linney says). There's also a session that features an overview of the employment marketplace by J. Larry Tyler, president of Tyler & Co., an executive search firm, one of three principal CPE instructors.

And then there's also an hourlong session on the third day called, How to Find Information on the Internet. Could it be recast as Internet 101 or Computing for Dummies? "I can't imagine someone having an MBA and needing that," Biggs says. "If you have an MBA, you know how to find things on the Internet."

On the final day, each candidate makes a five-minute presentation to an assessment panel, describing "their medical management skills and accomplishments" and demonstrating their "effective presentation skills," according to the ACPE's Web site. After the videotaped session, panel members judge the candidates based on their communication skills, presentation, responses to questions and knowledge of "medical management education resources." Linney says "5% or less" of the candidates are "deferred," or fail to receive their certificate. Those individuals are given the opportunity to resubmit a video for re-taking the written test that covers nine core healthcare management courses-health law, managing physician performance, quality, ethics, financial decisionmaking, marketing, influence, negotiation and informatics.

So far, physician-executives haven't had much luck in getting their ever-evolving job responsibilities designated an official "specialty" by the American Board of Medical Specialties, a national group that oversees physician certification by 24 medical-specialty boards. A formal request was made in late 1989 by the ACPE's American Board of Medical Management, says Alexis Rodgers, the group's director of operations and publications. At the time, she says, the organization did not feel that the physician-managers met the strict guidelines for special board certification.

Ray Fernandez, a physician who joined the ACPE in the 1980s when it was called the American Academy of Medical Directors, says the constantly changing CPE program is another step toward full-fledged accreditation of doctor-executives as board-certified specialists in that area. Fernandez, CEO and chief medical officer of the Piedmont Clinic in Atlanta, says doctors like himself and officials with the trade group recognized that some form of national criteria, testing and accreditation was needed to set physician-leaders apart as especially qualified for management roles.

As far as Fernandez is concerned, he is as much of a specialized physician-executive as he is a board-certified internist with a subspecialty in infectious diseases. "I'm a medical director, as opposed to being a clinician. If I were fired from one job, would I look for a new one as an infectious-disease specialist or a physician-executive? When I answered that by saying, `physician-executive,' I realized I'd crossed over the magic dividing line."

Advantage for younger managers

Fernandez, a 61-year-old veteran physician-executive who has held his CPE diploma for about 10 years, says the certification doesn't provide much added luster to his resume or future job prospects because of his long-established credentials, which include his move from medical director to CEO of the Charlotte, N.C.-based Nalle Clinic almost two decades ago. But the ACPE's equivalent of board certification is a big advantage for younger doctor-managers, he says.

"For the young doctor-somebody who's just made the decision to get into management-I think this would be extremely important for them. If I were out there right now hiring my replacement," he says, "I'd want to look for someone who has demonstrated some ability that they could do the job, so I would immediately accept certification by the ACPE board."

But officials with the ACPE say it's highly unlikely, even in the distant future, that the national governing body will decide to create and certify an entirely new medical specialty in the decidedly nonmedical category of physician-manager or doctor-executive. For now, at least, graduates will have to be happy with an ACPE-sponsored diploma.

"Based on our experience with the American Board of Medical Specialties in the early-to-mid-1990s," says Roger Schenke, the ACPE's executive vice president, "it became clear that medical management would not be acceptable to some of the larger specialty boards even if it were to be introduced as a `sub-specialty' on the already approved American Board of Preventive Medicine. Nothing has changed that would suggest any change in thinking by the specialty boards."

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